In the final of a three-part series that began on Sunday, Dr Lall Sawh talks about the equipment used in the urology department at the Port of Spain General Hospital, where he worked for 19 years as the consultant. He also answers critics who say that many doctors working in the Public Service frustrate the patients into paying for treatment at their private practice.

With so many technological advances in the field of urology, the equipment available to treat diseases such as prostate cancer has become more sophisticated and less invasive, Dr Sawh pointed out. His private practice at Southern Medical Clinic has the latest software and technology to detect and treat cancer; imaging is so clear and sharp, they can easily pinpoint the location and perimeters of malignant tumours, as well as for radiation therapy. But at Port of Spain General Hospital the equipment was always outdated because it took so long to get it.

NM: You were the consultant urologist at Port of Spain General Hospital. Didn’t you have a say in what should be purchased, what you needed to get the job done?

LS: For years, every year, I would write my requisition list, what I called my wish list. It goes through the normal channel. I hear nothing of it. Only once in my career of 19 years in Port of Spain did they invite me to a tenders committee where three or four manufacturing firms submitted a proposal. Only once-and they did buy some equipment. That was just before I left, actually. So, that was very late on in my career.

I used to take my own personal scopes to operate on patients just so that I could get the job done because the Government never provided any. Now you have to understand that urology changed so dramatically-most of our surgery now is endoscopic; it’s high-tech. I’m no longer cutting. When the Government buys a knife and a retractor, you can use that over and over and boil it. Not so with high-tech equipment. You need not only to upgrade it, you need to maintain it and you need to make sure it’s serviceable. And they never, never purchase. When I went to Port of Spain, the instruments were in little cardboard boxes shoved in a cupboard. And most of them were non-functional or incompatible with each other. In other words, they bought a piece of this and a piece of that and they didn’t fit.

NM: You’re getting me more and more scared.

LS: So I used to carry my own equipment, especially when I had to do children. I took in my paediatric equipment as well. I couldn’t have children suffering for surgery. And the adults, wherever possible, I would take my own instruments. These instruments would allow you to do a particular operation without having to cut your patient, so recovery is dramatic and prompt. Return to normalcy is like a couple days. Pain is almost nil because this is new, high-tech surgery in urology. And in other fields, but more so in urology. Things have been revolutionised.

NM: And when you left there was no sign of Port of Spain looking like a First World hospital?

LS: Not at all. Not in the least. And despite all our best efforts.

NM: What happened to our health sector reform programme, which started in 1997?

LS: Well, I guess it’s still being reformed. You see, there are several issues. In the same breath I’m crying out for equipment. But it makes no sense to buy high-tech, expensive equipment and you don’t have somebody who could maintain them. We don’t have service contracts so when they go bad you can have them repaired and replaced instantly.

NM: But these things happen in the private nursing homes.

LS: Of course they happen in the private sector because somebody’s money goes out to pay for them. When it’s Government’s money, nobody seems to care. You have a bio-medical service and unfortunately for these guys they’re willing but instruments change every year. Technology changes and they can’t keep ahead of that. And worse yet, when they do buy from the local suppliers, their people come with a catalogue-they don’t have a clue what they’re selling.

When you go to international meetings, the manufacturers are there exhibiting their wares. You can take it, use it. They will have little models to demonstrate it. Doctors should be encouraged to go to these exhibitions as well as update their [training].

Play with these things, literally, play with them, use them. Say to the Government, I like what I see. Manufacturer X has this. And why can’t the Government, which spends so much money, buy directly from the manufacturers? Why you paying the middle man all that money, who don’t know what the hell he is selling?

And furthermore, when anything goes wrong, and you buy it from the manufacturer, they will replace it or they will repair it-and you make sure that the contract has built into it a repair and service contract so if you buy a telescope that costs US$20,000 and it goes on the blink in a few months, the guarantee is acceptable, they will give you a new one while they repair that one or replace it or whatever. So you don’t waste money. That’s what we do in private enterprise. You think I could buy a US$20,000 telescope every Monday morning? I can’t.

On the topic of doctors who work in the public service but also have private practices.

LS: The people who come to our service in the government service, you know, hardly have taxi fares or bus fares to come. They can’t go to private care. And then the Minister of Health will get up and tell the population, ’Oh these doctors don’t want to do the work because they want to send the patients to their private practice.’ This patient can’t go to private practice! So who’s going to send them into private practice?

When you do that, you agitate an already frustrated public and they take it out on the clinic. I started to work in the days when the patient come to you with such gratitude, they’ll bring an egg, a piece of dasheen or yam for you because that’s what they could afford. Just to say thank-you.

Now you get cuss because, ’Oh, allyuh only want we to come in the private practice.’

I get cussed in the clinic, like many others, because the Ministers coming and talking nonsense about the doctors being greedy and want the patients to come to their private practice. The patients believe that.

When you tell them, I can’t do your surgery until three months or four months, or whenever, or we have to postpone it today because time is done and we haven’t got the surgeries done.

They feel you really trying to frustrate them to make them go outside. Because they just hear from the Minister of Health.

NM: Well, I have to tell you that it is a very strong perception out there that that is what the public and private practice doctors are up to. They’ll tell you I can’t do anything for you here. Come and see me in my private practice and I’ll take care of you there.

LS: They have a few doctors who do that. Let me tell you something, I made it a policy in all my years of service that I will not see a Government patient in my office. For many reasons: one, it’s a conflict of interest and two, if you do see a patient in your private office and that person returns back to the hospital service, they expect priority treatment and that’s not fair.

My secretaries were trained that once you see Dr Sawh in the Government clinic, no matter what change your mind, he not seeing you. Please go by somebody else.

If you wanted to come to me privately in the first place, you quite welcome to come.

You don’t come after you try the government service and say, ’Lemme see if I pay a visit fee out there to get priority in hospital.’ It doesn’t work so.

But I agree with you, I know of one doctor in urology who does that nonsense. And that should be stopped, but you mustn’t go and brand every doctor with that label.

NM: But there should be ways to.

LS: It’s easy to do.

NM: Well, this may seem outrageous but don’t you think doctors who work in the Public Service should not be allowed to have a private practice?

LS: Pay them properly. Give them enough incentive. Make sure they can go to their update conferences and upgrade their skills. Make sure you support them, and fine!